Nutrient Requirements

Abstract

Aggressive nutritional treatment is frequently necessary in the management of children with chronic renal disease. Failure to provide adequate calories and nutrients may aggravate the signs, symptoms, and secondary effects of renal disease (Table 1). Nutritional therapy is frequently difficult not only because losses may be excessive, but also because a sick child may be anorexic. Children with renal disease in particular may be depressed, just not hungry, or may vomit and have diarrhea. As a result, protein metabolism is decreased. Often, the physician is limited to correcting the detected chemical errors; and correction of one serum abnormality may produce another. Many secondary errors, particularly those related to hormonal deficits or excesses, and especially those related to secondary messengers cannot be approached with present knowledge. Dehydration, overhydration, electrolyte imbalance, acidosis, and hypertension are common. Osteodystrophy, rickets and central nervous system abnormalities occur. Least understood is the growth failure and the many factors causing this in children with chronic nephritis.